The common factors in the fecal-oral route can be summarized as five Fs: fingers, flies, fields, fluids, and food. Diseases caused by fecal-oral transmission include typhoid, cholera, polio, hepatitis and many other infections, especially ones that cause diarrhea.
Villagers during a community-led total sanitation (CLTS) triggering exercise go to the place where meals are prepared to observe how flies are attracted to human feces and carry diseases by landing on the food (village near Lake Malawi, Malawi)School children during a CLTS triggering event in West Bengal, India looking at a glass of water and fresh human feces where the flies pass from the water to the feces and back. This demonstrates how pathogens can pollute water.
Although fecal–oral transmission is usually discussed as a route of transmission, it is actually a specification of the entry and exit portals of the pathogen, and can operate across several of the other routes of transmission.[1] Fecal–oral transmission is primarily considered as an indirect contact route through contaminated food or water. However, it can also operate through direct contact with feces or contaminated body parts, such as through anal sex.[2][3] It can also operate through dropletorairborne transmission through the toilet plume from contaminated toilets.[4][5]
The foundations for the "F-diagram" being used today were laid down in a publication by the World Health Organization (WHO) in 1958.[6] This publication explained transmission routes and barriers to the transmission of diseases from the focal point of human feces.[citation needed]
Modifications have been made over the course of history to derive modern-looking F-diagrams. These diagrams are used in many sanitation publications.[7] They are set up in a way that fecal–oral transmission pathways are shown to take place via water, hands, arthropods and soil. To make it easier to remember, words starting with the letter "F" are used for each of these pathways, namely fluids, fingers, flies, food, fields, fomites (objects and household surfaces).[citation needed]
Rather than only concentrating on human feces, feces from other animals should also be included in the F-diagram.[7]
The sanitation and hygiene barriers when placed correctly prevent the transmission of an infection through hands, water and food. The F-diagram can be used to show how proper sanitation (in particular toilets, hygiene, handwashing) can act as an effective barrier to stop transmission of diseases via fecal–oral pathways.[citation needed]
The process of transmission may be simple or involve multiple steps. Some examples of routes of fecal–oral transmission include:[citation needed]
water that has come in contact with feces (for example due to groundwater pollution from pit latrines) and is then not treated properly before drinking;
by shaking someone's hand that has been contaminated by stool, changing a child's diapers, working in the garden, or dealing with domestic animals;
food that has been prepared in the presence of fecal matter;
Modified F-diagram including interventions that can block human exposure to animal feces.[7]
One approach to changing people's behaviors and stopping open defecation is the community-led total sanitation approach. In this process "live demonstrations" of flies moving from food to fresh human feces and back are used. This can "trigger" villagers into action.[8]
The list below shows the main diseases that can be passed via the fecal–oral route. They are grouped by the type of pathogen involved in disease transmission.[citation needed]
^LaMorte, Wayne W. (2016-01-06). "Common Vehicle Spread". Boston University School of Public Health. Archived from the original on 2020-05-14. Retrieved 2020-07-21.
^Whittier, Christopher A (2017-04-16), "Fecal-Oral Transmission", in Bezanson, Michele; MacKinnon, Katherine C; Riley, Erin; Campbell, Christina J (eds.), The International Encyclopedia of Primatology, Hoboken, NJ, USA: John Wiley & Sons, Inc., p. 1, doi:10.1002/9781119179313.wbprim0193, ISBN978-1-119-17931-3
^Wagner, E. G., and Lanoix, L. N. (1958). Excreta disposal for rural and small communities(PDF). WHO, Geneva, Switzerland. p. 12. Archived from the original on 2020-04-12. Retrieved 2016-08-26.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: multiple names: authors list (link)
^Hale TL, Keusch GT (1996). Baron S, et al. (eds.). Shigellain: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN978-0-9631172-1-2. (via NCBI Bookshelf).
^Giannella RA (1996). Baron S; et al. (eds.). Salmonella:Epidemiology in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN978-0-9631172-1-2. (via NCBI Bookshelf).
^Finkelstein RA (1996). Baron S; et al. (eds.). Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibriosin: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN978-0-9631172-1-2. (via NCBI Bookshelf).
^Zuckerman AJ (1996). Baron S; et al. (eds.). Hepatitis Viruses in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN978-0-9631172-1-2. (via NCBI Bookshelf).
^Meyer EA (1996). Baron S; et al. (eds.). Other Intestinal Protozoa and Trichomonas Vaginalisin: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN978-0-9631172-1-2. (via NCBI Bookshelf).
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